BMJ quality & safety
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BMJ quality & safety · Sep 2013
Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery.
When comparing mortality rates between hospitals to explore hospital performance, there is an important role for adjustment for differences in case-mix. Identifying outcome measures that are less influenced by differences in case-mix may be valuable. The main goal of this study was to explore whether hospital differences in anastomotic leakage (AL) and postoperative mortality are due to differences in case-mix or to differences in treatment factors. ⋯ Hospital variation in AL is relatively independent of differences in case-mix. In contrast to 'postoperative mortality' the observed AL rates of hospitals evaluated in our study were only slightly affected after adjustment for case-mix factors. Therefore, AL rates may be suitable as an outcome indicator for measurement of surgical quality of care.
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BMJ quality & safety · Aug 2013
Multicenter Study Observational StudyInterruptions in emergency department work: an observational and interview study.
Frequent interruptions are assumed to have a negative effect on healthcare clinicians' working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments. ⋯ Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.
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BMJ quality & safety · Aug 2013
Multicenter Study Observational StudyThe 'time-out' procedure: an institutional ethnography of how it is conducted in actual clinical practice.
The time-out procedure is a critically important communication interaction for the preservation of patient safety in the surgical setting. While previous research has examined influences shaping the time-out procedure, limited information exists on how actual time-out communication is performed by multidisciplinary surgical team members in the clinical environment. ⋯ Patient safety was relegated in importance as productivity, professional and hierarchical discourses configured the communication practices of surgical team members to limit active, open and direct communication. Examining how the time-out procedure was conducted in the clinical environment enables possibilities to emerge for facilitating compliance with hospital and WHO guidelines.
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BMJ quality & safety · Aug 2013
Observational StudyIs the Surgical Safety Checklist successfully conducted? An observational study of social interactions in the operating rooms of a tertiary hospital.
To determine whether the items on the Time Out and the Sign Out of the Surgical Safety Checklist are properly checked by operating room (OR) staff and to explore whether the number of checked items is influenced by the severity of the intervention and the use of the checklist as a memory tool during the Time Out and the Sign Out periods. ⋯ Training on the proper completion of the checklist must be provided to OR teams. The severity of the interventions influenced the number of items properly checked.